The COVID-19 pandemic had and still has enormous influence on patient care in hospital and outpatient department settings. In our study, we aimed to analyze if there had been a significant impact on the psycho-oncological screening outcome in neuro-oncological patients during the first wave of the COVID-19 pandemic due to restrictions in professional patient care and family supportive systems.

In our cohort, prevalence of distress and anxiety did not significantly differ in neuro-oncological patients who were screened pre-COVID and post-COVID first wave. We could observe, even though results were not statistically significant, that mean scores for both screening parameters were higher in the pre-COVID screening group. On the contrary, depression prevalence and mean scores in the depression screening were higher during the COVID-19 screening than before the start of the pandemic in 2020, and the results only narrowly failed to reach significance.

4.1. Clinical ImplicationsIn line with our results, an online cross-sectional study, not focusing on patients but standard population with 15.000 participants in Germany published in 2020, showed that prevalence of depression increased under COVID-19 from 5.6 % to 14.3 % [26]. In another meta-analysis focusing on depression and distress in another very special population—health-care workers—analyses of 65 studies revealed the pooled prevalence of depression in 21.7% and 22.1% for anxiety [27]. In comparison, we observed a depression prevalence of 26% and 15% for anxiety in our neuro-oncological patient’s cohort. These results underline that the cohorts not involved in the medical environment either professional or as a patient tend to have lower levels of depression under COVID-19 and vice versa, but also in the general population prevalence of depression increased. Recently, Obispo-Portero et al. reported their study results of 401 cancer patients with an overall higher prevalence of depression and anxiety under COVID-19 in patients with advanced cancer diagnoses and additionally found that younger age 28]. Already in 2010, in times when a worldwide pandemic seemed to be a historical incident, Hinz et al. reported that cancer patients are generally at higher risk for depression and anxiety compared to the general population; and particularly in younger patients, prevalence was nearly twice as high in their analysis. On the contrary, the tumor stage also did not have any significant influence comparable to the findings of Obispo-Portero et al. [29].In our cohort age, recurrent diagnosis and entity of diagnosis, either malignant or benign, had no influence on the psycho-oncological outcome of the patients independently of screening timepoint. However, we actually had expected some higher distress levels in patients with recurrent diagnosis as there are specific timepoints reported in the literature in neuro-oncological patients where an increased distress was observed, especially during hospitalisation as well as at the time point of tumour recurrence [30], which might be due to various general apprehension when diagnosed with recurrent cancer.

In our additional analysis of specific items of the quality-of-life questionnaire, we found that there was no statistical difference in social-functioning, cognitive-functioning, emotional functioning, role functioning, physical functioning and global health status in both of our subgroups; and interestingly, under COVID-19, patients did not ask for professional support more often under COVID-19.

Our data show that circumstances that came along with the first wave of COVID-19 did not have significantly negative effects on the psycho-oncological outcome of our neuro-oncological patients.

In consideration of what we have learned from recent studies, these results were somehow surprising to the authors. We know that neuro-oncological patients tend to have higher distress levels when they are hospitalized or in recurrent situations. We hypothesized that under COVID-19 these effects would have been even more increased. On the contrary, our cohort did not show significant differences in both groups and recurrent diagnoses did also not correlate with higher scoring results.

There are some points that might have contributed to that fact the authors would like to point out.

Firstly, patients who are diagnosed with brain tumors are burdened due to the diagnose to such an extent and focused so much on that mostly felt life-threatening incident that further external influences might not play such a great role to them. Taking that into consideration, maybe the patients’ relatives were the ones who suffered from COVID-19 restrictions even more due to strict visiting hours or even visiting interdictions and the subjective feeling to be even more helpless due to these special circumstances.

Another aspect of the patient relative relationship is that we have learned from different studies that used Fear of Progression Questionnaires (FoP-Q) that both parts tend to the mutual burden each other. One can hypothesize that the more distant relationship under the COVID-19 pandemic might have a positive influence on some patients’ disease and therapy perception.

On the contrary, the restrictions of the first wave of the COVID-19 pandemic unarguably have led to enormous changes for hospitalized patients, particularly when it comes to availability of family support systems, especially for those patients who strongly depend on family care structures. In our department, we aimed to connect closely with patients’ families via daily phone calls and encouraged patients and families to make use of multi-media devices to keep up their daily contact.

The use of these tools to overcome the visiting restrictions as well as the engagement of additional urgent professional support whenever special needs were diagnosed might have contributed to the reported results, which we evaluate as positive findings under the given circumstances.

4.2. Limitations

Regarding sensitivity and specificity of the used measures for the diagnosis of certain psychiatric diseases such as anxiety and depression, there are different cut-off values published and used in the literature. That might lead to different numbers of diagnoses in patient cohorts when different cut-offs are used. Nevertheless, in the present study, the questionnaires were only used as screening instruments not as a diagnostic tool, and there is a wide range of published data agreeing about feasibility as screening instruments.

At last, concerning the requirement of psycho-oncological support and EORTC-C30-BN20 datasets, we can only report analysis of limited datasets as there were only 27 instead of 48 datasets in group A and only 59 instead of 62 patients’ datasets available for group B (psycho-oncological support) and only 37 instead of 62 datasets in the EORTC-Bn20 screening for group B. A further limitation is the arguably very specific and small subgroup of neuro-oncological patients who also split into further subgroups of benign and malign diagnoses. Nevertheless, as we could show that the entity of diagnosis had no significant influence, our results can be conveyed to the subgroup of neuro-oncological patients. However, the small number of patients could also have contributed to our findings reported above.